Mowbray House Surgery

Updated 26 January 2017

Mowbray House Surgery, Malpas Road, Northallerton, North Yorkshire DL7 8FW

is situated in the town centre of Northallerton with a branch surgery at Hutton Rudby village. The main practice is housed in a purpose built medical centre and owned by the partners. There is parking with some of the patients living within walking distance and there is limited access to public transport. The branch surgery is housed in a converted building in the centre of the village of Hutton Rudby. The practice also hold weekly branch surgery at Appleton Wiske, we did not visit this location as it was closed at the time of the inspection. The practice covers a wide rural area. There are19792 patients on the practice list of which 8900 were registered as patients using the dispensary. The practice scored eight on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

There are eight GP partners four male, four female. There are six salaried GPs four female and two male. There is one advanced nurse practitioner, six practice nurses, five health care assistant (HCA) and an attached urgent care practitioner. There is a practice manager, departmental leads and administrative staff. The practice has a dispensing technician and dispensing staff working across both sites. The practice works closely with the clinical commissioning group (CCG) and federation.

The practice is open from 8am to 6.30pm, Monday to Friday. The practice provides extended hours one evening per week until 8pm and on a Saturday morning from 8.30am until noon. Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s emergency service which is manned by a team of local GPs and operates from Northallerton between the hours of 6.30pm to 8 am and all day on Saturdays, Sundays and Bank Holidays. The practice holds a General Medical Service (GMS) contract.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mowbray House Surgery 30 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. When a complaint related to any aspect of clinical work it was raised as a significant event.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day and pre bookable appointments available.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure in place. The practice proactively sought feedback from staff and patients, which it acted on. The provider was aware of and complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

We saw several areas of outstanding practice:

• The practice had developed an acute care team which included paramedics employed by the practice responding to acute care needs and requests for home visits.

• The practice had developed a range of patient leaflets to inform patients prescribed certain medicines such as anti-inflammatory medicines, diuretics and diabetes medicines what they should do if they become unwell with conditions such as diarrhoea and vomiting. The administration staff had created a clinical software tool which prompted the prescriber to offer a ‘sick day rules’ leaflet to the patient.

The practice SHOULD:

• Implement expiry date checking of medicines at Mowbray House.

• Follow standard operating procedures in relation to cold chain storage to ensure compliance with national guidelines.

• Manage Patient Specific Directions in line with national guidance.

• Patient’s records are appropriately updated after review has taken place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. There was a joint approach in managing these patients with community and district nurses. The practice promoted self-management by using care plans for asthma and Chronic Obstructive Airways Disease (COPD).

• Patients with COPD, asthma and diabetes were managed by nurse led clinics and GPs. Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 90% compared to the CCG of to the national average of 83% and the CCG average of 80%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicine needs were being met.

• The practice promoted self-management for some long term conditions and referred patients for ongoing support where required.

Updated 26 January 2017

The practice is rated as good for the care of families, children and young people.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 83% compared to the local CCG average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The staff informed the GP of any request for a same day appointment or visit for a child so that they could be triaged quickly.

• We saw positive examples of joint working with multidisciplinary teams, midwifes health visitors and school nurses.

• The practice provided access to contraception and screening for sexually transmitted diseases (STDs).

• The practice offered six week post-delivery checks for mothers and babies.

Updated 26 January 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• All patients over 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home and urgent appointments for those with enhanced needs.

• The practice had a process in place to regularly visit patients in care homes.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. Those patients who had an unplanned admission or presented at Accident and Emergency (A&E) had their care plan reviewed. Care plans were reviewed and discussed.

• The GPs reviewed 111 contacts and planned follow up care as necessary.

• The practice offered a home delivery service to those patients registered with the dispensary and unable to collect their prescriptions.

Updated 26 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice had range of appointments available on a Monday evening, Saturday morning and telephone consultations.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 26 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Nationally reported data from 2014/2015 showed 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, compared to the local CCG average of 86% and the national average of 84%.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 95%, which was 1% below the CCG average and 4% above the national average.

• The practice undertook regular patient reviews in their own home or in the surgery. Those patients who had not attended were followed up with an invitation letter or with a phone call.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice held monthly meetings with the community psychiatrist to discuss dementia care plans.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients suffering acute mental health issues were seen on the same day and had access to the crisis team locally.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Patients on medicines requiring regular monitoring and where the practice shared their care with mental health services were monitored regularly.

Updated 26 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances and provided a supportive and non-judgemental approach. Examples of these patient groups were people with drug and alcohol problems and those living with a learning disability. There were same day appointments available for those in crisis

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice, 40% of patients on the register had received an annual review.

• The practice had a named nurse and GP for learning disabilities. The practice regularly worked with other health care professionals in the case management of vulnerable patients. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice held regular Gold Standards Framework (GSF) palliative care meetings to discuss and agree care plans. It involved the practice working together as a team and with other professionals in hospitals, hospices and specialist teams to provide the highest standard of care possible for patients and their families.